{
  "abstract": "Objectives To perform the first-in-human concomitant robotic liver resection and cone-beam CT (CBCT)-guided ablation in a hybrid operating room (HARMONY).Design IDEAL stage 0/1 study outlining the preparatory steps and outcomes of the first-in-human HARMONY procedure. IDEAL stage 0 involved conceptualisation, team training and dry runs. The first HARMONY procedure was performed and the procedural technique is described in detail.Setting All procedures took place at a single academic medical centre.Participants Patients eligible for the HARMONY procedure are any adults eligible for combined ablation and resection of colorectal liver metastases. The HARMONY procedure was performed in a first patient. Outcomes of patients who underwent sequential robotic liver resection and CT hepatic arteriography-guided liver ablation in the preparatory phase are also reported.Intervention Concomitant robotic liver resection and CBCT-guided ablation in a hybrid operating room.Main outcome measures The primary outcome was technical feasibility of the HARMONY procedure defined as the technical success of both the robotic surgical resection and CBCT-guided ablation within the hybrid operating room.Results Between 2018 and 2024, 19 patients underwent sequential robotic liver resection and CT-guided ablation. Median interval between procedures was 4 days, with 36.8% treated during one admission. Intraoperative incidents occurred in three (15.8%) patients and two (10.5%) patients experienced severe complications requiring reintervention. The first-in-human HARMONY procedure was successfully completed without intraoperative complications.Conclusions The concomitant performance of robotic liver resection and CBCT-guided ablation is technically feasible in a hybrid operating room. Future studies should evaluate its reproducibility, safety and long-term outcomes.Trial registration number CCMO Research with human participants (NL-009169).",
  "authors": [
    {
      "affiliations": [
        "Department of Surgery, Amsterdam UMC, the University of Amterdam, Amsterdam, The Netherlands",
        "Cancer Center Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Gabriela Pilz da Cunha"
    },
    {
      "affiliations": [
        "Cancer Center Amsterdam, Amsterdam, The Netherlands",
        "Department of Nuclear Medicine and Radiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands"
      ],
      "name": "Hannah H Schulz"
    },
    {
      "affiliations": [
        "Department of Surgery, Amsterdam UMC, the University of Amterdam, Amsterdam, The Netherlands",
        "Cancer Center Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Tijs J Hoogteijling"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands"
      ],
      "name": "Maarten LJ Smits"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands"
      ],
      "name": "Katrin Stoecklein"
    },
    {
      "affiliations": [
        "Cancer Center Amsterdam, Amsterdam, The Netherlands",
        "Department of Nuclear Medicine and Radiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands"
      ],
      "name": "Martijn R Meijerink"
    },
    {
      "affiliations": [
        "Department of Surgery, Amsterdam UMC, the University of Amterdam, Amsterdam, The Netherlands",
        "Cancer Center Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Rutger-Jan Swijnenburg"
    }
  ],
  "title": "Staged introduction of a first-in-human concomitant robotic liver resection and cone-beam CT-guided percutaneous liver ablation in a hybrid operating room (HARMONY): an IDEAL stage 0/1 study",
  "uid": "69d46dc0-def6-5685-9cca-30d8a3bf6782"
}